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Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine
1Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
The Journal of Headache and Pain
|September 28, 2017
Summary
Neck pain in migraine patients is linked to upper cervical spine joint dysfunction. Palpation can identify these issues, potentially revealing migraine subtypes and guiding treatment for reduced pain input.
Area of Science:
- Neurology
- Musculoskeletal Medicine
- Pain Management
Background:
- Migraine patients frequently experience neck pain before or during attacks.
- Neck pain in migraine is associated with specific muscle and joint alterations.
- Upper cervical spine joint dysfunction is more common in migraine sufferers.
Purpose of the Study:
- To investigate the link between upper cervical spine musculoskeletal dysfunction and migraine.
- To determine if palpation of the upper cervical spine can aid in migraine diagnosis and stratification.
Main Methods:
- 179 migraine patients and 73 healthy controls underwent palpation of the upper cervical spine by a blinded physiotherapist.
- The palpation technique involved oscillating movements and sustained pressure.
Main Results:
- Migraine patients could be stratified into pain-free (11%), local pain (42%), and referred head pain (47%) groups based on palpation response.
- Combined palpation and sustained pressure demonstrated high sensitivity and specificity for identifying migraine.
Conclusions:
- Palpation of the upper cervical spine may help identify migraine subtypes.
- Addressing upper cervical spine musculoskeletal dysfunction is crucial to reduce nociceptive input into the trigeminocervical complex.
